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Intraoperative Neurophysiological Monitoring During Microsurgery for Solid Medullary Hemangioblastoma

目的 探討顯微切除延髓實體性血管母細胞瘤術中電生理監測的意義。 方法 2007年7月-2009年8月，在電生理監測下顯微切除13例延髓實體性血管母細胞瘤，觀察切除程度、死亡率及術后腦干功能，并對電生理監測下的手術技巧進行討論總結。 結果 完全切除13例延髓實體性血管母細胞瘤，術后因呼吸功能衰竭死亡1例，6個月腦干機能狀態較術前保持或改進10例。 結論 延髓實體性血管母細胞瘤切除術中行神經電生理監測有助于提高手術效果，改善預后。

Summary on magnetic resonance imaging, and pathological and clinical characteristics of 26 multiple sclerosis patients with new lesion in medulla oblongata

ObjectiveTo evaluate the magnetic resonance imaging (MRI) manifestations, pathological and clinical characteristics, and treatment outcomes of multiple sclerosis (MS) patients with new lesion in medulla oblongata (MO).MethodsPubMed, EBSCO, and Springer databases between January 1st, 2000 and May 1st, 2018 were searched with the combined keywords of " multiple sclerosis” and " medulla oblongata”. Furthermore, the MS patients’ MRI manifestations, pathological and clinical characteristics, and treatment outcomes were summarized.ResultsA total of 18 papers were involved, in which 26 patients were included. The lesions in MO were mainly showed by wedge-shape (9/20), and round or oval-shape (9/20) in axial head MRI. Inflammatory cells infiltration and acute demyelination in the new lesions of MO had been displayed by autopsy reports of two MS patients. The new lesions in MO mainly referred to various types of nystagmus (9/26), left ventricular apical ballooning syndrome (LVABS) (8/26), neurogenic pulmonary edema (NPE) (6/26), and acute heart failure (6/26). Nucleus tracts solitaries (NTS), along with dorsal motor nucleus of the vagus nerve and medial reticular formation (MRF), was related to LVABS and NPE. Intercalatus nucleus, Roller nucleus and/or autonomic nerve structure were related to various types of nystagmus.ConclusionsIn axial head MRI, the new MS lesions in MO were mainly wedge-shape and round or oval-shape. Beyond that, the new MS lesions in MO could involve NTS, dorsal motor nucleus of the vagus nerve, MRF, intercalatus nucleus, Roller nucleus and/or autonomic nerve structure, resulting in special clinical features, such as, nystagmus, LVABS, NPE, and acute heart failure. Corticosteroid is still the main treatment to relieve the clinical manifestations caused by new MS lesions in MO.

延髓腫瘤患者術后呼吸道護理

目的　討論延髓腫瘤患者術后呼吸道護理方法。 方法　對2009年10月－2011年3月86例延髓腫瘤患者術后呼吸道護理措施進行回顧性分析。 結果　治愈78例，5例好轉，3例因呼吸衰竭死亡。術后插管治療中，9例發生肺部感染，但無1例發生誤吸。 結論　術后加強呼吸功能的觀察與護理，防止窒息，保持呼吸道通暢對患者的預后起著至關重要的作用。

康復治療延髓梗死后呼吸及吞咽功能障礙一例

Clinical Analysis of Medulla Oblongata Tumor

目的　探討延髓腫瘤的治療策略，以達到最佳預后。 方法　回顧分析2007年1月－2010年12月19例延髓腫瘤患者的臨床資料，其中18例經外科手術治療和病理證實，1例通過影像學確診。 結果　12例血管網狀細胞瘤中，11例手術全切，1例手術次全切；2例室管膜瘤均手術全切；2例海綿狀血管瘤分別手術全切及伽馬刀治療；3例膠質瘤均手術部分切除。18例手術治療患者術后神經功能障礙明顯好轉者13例，無明顯變化者3例，2例因術后嚴重并發癥死亡；1例伽馬刀治療患者癥狀好轉。術后隨訪6～48個月，平均24個月。11例恢復工作，4例生活可自理，2例因腫瘤復發死亡。結論　術前通過MRI檢查、術中神經電生理監測及熟練的顯微外科技術是外科治療優勢，伽馬刀治療延髓較小腫瘤有著損傷小的優點，因此制定合理的治療策略有利于提高患者生存質量。